This sheet is about exposure to apremilast in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider.

What is apremilast?

Apremilast is a prescription medication that has been used to treat the symptoms of moderate to severe psoriasis and psoriatic arthritis, plaque psoriasis, and oral (mouth) ulcers associated with Behcet’s disease. A brand name of apremilast is Otezla®. For information about psoriasis and psoriatic arthritis, please see the MotherToBaby fact sheet at: https://mothertobaby.org/fact-sheets/psoriasis-and-pregnancy/.

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.

I take apremilast. Can it make it harder for me to get pregnant?

It is not known if apremilast can make it harder to get pregnant. However, animal studies have not shown a negative effect on fertility.

Does taking apremilast increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies in humans have not been done to see if apremilast increases the chance of miscarriage. Animal studies found a greater chance of miscarriage with higher doses of apremilast than what is used in humans.

Does taking apremilast increase the chance of birth defects?

Every pregnancy starts out with a 3-5% chance of having a baby with a birth defect. This is called the background risk. Studies in humans have not been done to see if apremilast increases the chance of birth defects. Animal studies did not find an increased chance of birth defects.

Does taking apremilast in pregnancy increase the chance of other pregnancy-related problems?

Studies in humans have not been done to see if apremilast increases the chance for pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Animal studies found a higher chance of low birth weight offspring with higher doses of apremilast than what is used in humans.

Does taking apremilast in pregnancy affect future behavior or learning for the child?

Studies have not been done to see if apremilast can cause behavior or learning issues for the child.

Breastfeeding while taking apremilast:

Apremilast has not been studied in humans for use while breastfeeding. Animal studies showed that apremilast gets into breast milk in small amounts. The product label for apremilast recommends women who are breastfeeding not use this medication. But the benefit of using apremilast may outweigh possible risks. Your healthcare providers can talk with you about using apremilast and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a man takes apremilast, could it affect fertility or increase the chance of birth defects?

Studies have not been done to see if apremilast could affect a man’s fertility (ability to get a woman pregnant) or increase the chance of birth defects above the background risk. In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

MotherToBaby is currently conducting a study looking at apremilast and other medications used to treat autoimmune diseases in pregnancy. If you are interested in taking part in this study, please call 1-877-311-8972 or sign up at https://mothertobaby.org/join-study/.

This sheet is about exposure to chlorpheniramine in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare provider. 

What is chlorpheniramine?

Chlorpheniramine is an antihistamine that has been used to relieve symptoms of allergies, hay fever (allergic rhinitis), and the common cold. These symptoms include sneezing, runny nose, watery eyes, and itchy throat. Chlorpheniramine is sold under different brand names, including Chlor-Trimeton®, Aller-Chlor®, Chlo-Amine®, Polaramine®, Teldrin®.    

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

I take chlorpheniramine. Can it make it harder for me to get pregnant? 

It is not known if chlorpheniramine can make it harder to get pregnant. 

Does taking chlorpheniramine increase the chance of miscarriage? 

Miscarriage is common and can occur in any pregnancy for many different reasons. Information from studies done on antihistamines including chlorpheniramine have not suggested an increased chance of miscarriage. 

Does taking chlorpheniramine increase the chance of birth defects? 

Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like chlorpheniramine, might increase the chance of birth defects in a pregnancy.  

Most studies find no overall increased chance of birth defects with the use of chlorpheniramine in pregnancy. While two studies found a small increased chance for different types of birth defects, no specific pattern of birth defects has been reported.  

Does taking chlorpheniramine in pregnancy increase the chance of other pregnancy-related problems?

Chlorpheniramine is not expected to increase the chance for pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).   

Does taking chlorpheniramine in pregnancy affect future behavior or learning for the child?  

Studies have not been done to see if chlorpheniramine can increase the chance of behavior or learning issues for the child.  

Breastfeeding while taking chlorpheniramine:

Information on the use of chlorpheniramine during breastfeeding is limited. No side effects were reported in 5 infants exposed to chlorpheniramine while nursing. Chlorpheniramine can cause sleepiness in adults and might cause the same effect in infants that are nursing. If you suspect the baby has any symptoms (such as drowsiness or irritability), contact the child’s healthcare provider. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

If a man takes chlorpheniramine, could it affect fertility or increase the chance of birth defects?

There are some case reports of low sperm activity with long-term antihistamine use in men. This might affect men’s fertility (ability to get a woman pregnant). This effect went away when the medications were stopped. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.  

Please click here to view references. 

This sheet is about exposure to olopatadine in pregnancy and while breastfeeding. This information is based on available research studies. It should not take the place of medical care and advice from your healthcare provider.

What is olopatadine?

Olopatadine is an antihistamine medication that has been used to treat some of the symptoms of allergies, like itchy eyes. It is sold as eye drops (under the brand names Pataday®, Patanol®, and Pazeo®) and nasal spray (under the brand name Patanase®). Olopatadine is also found in combination with mometasone furoate to treat seasonal allergies (Ryaltris®).

In general, eye drops and nasal sprays result in lower medication exposure for the pregnancy than oral (swallowed) medications.

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.

I take olopatadine. Can it make it harder for me to get pregnant?

Studies have not been done to see if olopatadine can make it harder to get pregnant.

Does taking olopatadine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done in humans to see if olopatadine can increase the chance of miscarriage.

Does taking olopatadine increase the chance of birth defects?

Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like olopatadine, might increase the chance of birth defects in a pregnancy. Studies have not been done in humans to see if olopatadine can increase the chance of birth defects.

Does taking olopatadine in pregnancy increase the chance of other pregnancy-related problems?

Studies have not been done in humans to see if olopatadine can increase the chance of pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).

Does taking olopatadine in pregnancy affect future behavior or learning for the child?

Studies have not been done to see if olopatadine can increase the chance of behavior or learning issues for the child.

Breastfeeding while taking olopatadine:

Olopatadine has not been well-studied for use while breastfeeding. It is not known if olopatadine passes into breast milk or what effects, if any, olopatadine might have on an infant who is breastfeeding. In general, eye drops and nasal sprays are not expected to get into breast milk in high amounts because they do not typically reach the blood stream. Be sure to talk to your healthcare provider about all your breastfeeding questions.

If a man takes olopatadine, could it affect fertility or increase the chance of birth defects?

Studies have not been done to see if olopatadine could affect a man’s fertility (ability to get partner pregnant) or increase the chance of birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.

Please click here for references.

This sheet is about exposure to clopidogrel in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare provider. 

What is clopidogrel? 

Clopidogrel is an antiplatelet medication that helps prevent blood clots. It has been used to help prevent heart attacks and strokes. A brand name for clopidogrel is Plavix®.  

Sometimes when women find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. 

I take clopidogrel. Can it make it harder for me to get pregnant?  

Studies have not been done to see if taking clopidogrel can make it harder to get pregnant. In animal studies, clopidogrel did not affect fertility (ability to get pregnant). 

Does taking clopidogrel increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. Studies have not been done to see if clopidogrel can increase the chance of miscarriage. Studies conducted on animals did not report an increase in miscarriages. 

Does taking clopidogrel increase the chance of birth defects?  

Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like clopidogrel, might increase the chance of birth defects in a pregnancy. 

Information on the use of clopidogrel in pregnancy is limited. In animal studies, clopidogrel did not increase the chance of birth defects. In 17 case reports of women taking clopidogrel during pregnancy, no birth defects were reported in 16 of the babies. A heart defect was reported in 1 baby. A single case report is not enough information to link an exposure to a birth defect. Also, in all of these reports, other medications were also taken during pregnancy. This makes it hard to know if clopidogrel, the combination of medications, or other factors are related to the reported heart defect.  

Does taking clopidogrel in pregnancy increase the chance of other pregnancy-related problems? 

Studies have not been done to see if clopidogrel can increase the chance for other pregnancy-related problems, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). 

Taking clopidogrel during labor or delivery may increase the chance of bleeding and hemorrhaging (too much blood loss) in the woman giving birth. There is also an increased chance of spinal hematoma (when blood collects in the spine) when women who take clopidogrel get an epidural (injection of medication into the space around your spinal nerves to provide pain relief (analgesia) or numbness in one area of the body). The product label and professional medical societies, including the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine, have recommended that anyone taking clopidogrel stop taking it 5-7 days before labor, delivery, or getting an epidural. 

Does taking clopidogrel in pregnancy affect future behavior or learning for the child?  

Studies have not been done to see if clopidogrel can increase the chance of behavior or learning issues for the child.  

Breastfeeding while taking clopidogrel: 

In two women taking clopidogrel, it was found that clopidogrel and its metabolites appeared in breast milk in minimal quantities, below the limit of detection. No side effects have been reported in a small number of infants exposed to clopidogrel through breast milk. If you suspect the baby has any symptoms (such as bruising or bleeding), contact the child’s healthcare provider.  

There is a theoretical (not proven) concern that if a baby is exposed to clopidogrel through breast milk, the baby’s platelets may not work correctly. This has not been noted in the reports on infants exposed to clopidogrel through breastmilk. 

If a man takes clopidogrel, could it affect fertility or increase the chance of birth defects? 

Studies have not been done in humans to see if clopidogrel could affect male fertility (ability to make healthy sperm) or increase the chance of birth defects. In animal studies, there were no reported effects on fertility. In general, exposures that men have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.  

Please click here for references. 

This sheet is about exposure to pesticides in pregnancy and while breastfeeding. This information is based on published research studies. It should not take the place of medical care and advice from your healthcare provider. 

What are pesticides?  

Pesticides are substances used to prevent or destroy “pests” such as weeds, insects, animals (rodents and other), fungus and parasites that can harm crops or people. For example, pesticides are used to lower the number of mosquitoes which may carry the Zika virus or parasites that cause diseases (like malaria) that can be spread to people. Pesticides used to kill weeds are called herbicides. Pesticides used to kill or prevent the growth of fungi and their spores are called fungicides.  

Pesticides sprayed outside with ground equipment or by aircraft are called outdoor pesticides. There are many household products that are also considered pesticides, such as cockroach spray, rat poison, or flea collars for pets. These products are known as indoor pesticides.  

This sheet talks in general about pesticides. Please contact MotherToBaby to see if there is more information on a specific product or ingredient that you have questions about. When calling, have a copy of the label nearby so that you can list the ingredients. 

How can pesticides get into my body?  

Pesticides can get into the body in several ways, such as breathing them in (inhalation), eating foods that were sprayed with pesticides (ingestion), or absorbing them through your skin. When outdoor pesticides are being sprayed, wind can carry some of the pesticide to other areas. Small amounts of outdoor pesticides can also be found in the food and water supply.  

What are some commonly used pesticides?  

There are many different kinds of pesticides used in the United States. Some commonly used pesticides are glyphosate (Round Up®), organochlorines pesticides (DDT, dieldrin, lindane), organophosphate pesticides (examples are malathion and naled) and pyrethrin and pyrethroid pesticides (example: Anvil®, Raid®).  

Can exposure to pesticides make it harder for me to get pregnant?  

Some studies have suggested that pesticides and herbicides might increase the chance for fertility problems while other studies have not. Contact a MotherToBaby specialist to see if there is information on the specific product that you have questions about. 

Will exposure to pesticides increase the chance of miscarriage?  

Miscarriage is common and can occur in any pregnancy for many different reasons. In 2 human studies, there were no reported effects on miscarriage from spraying several different pesticides. Some other studies have suggested that pesticides might increase the chance for miscarriage and stillbirth while others have not. As there can be many causes of miscarriage, it is hard to know if an exposure or other factors (age, health, medications used, medical conditions) are the cause of a miscarriage. Contact a MotherToBaby specialist to see if there is information on the specific product that you have questions about. 

Will exposure to pesticides increase the chance of birth defects?  

Birth defects can happen in any pregnancy for different reasons. Out of all babies born each year, about 3 out of 100 (3%) will have a birth defect. We look at research studies to try to understand if an exposure, like pesticides, might increase the chance of birth defects in a pregnancy. Most animal studies with glyphosate, organophosphates, organochlorines, pyrethrins, or pyrethroid exposure have not shown an increased chance for birth defects above the background risk.  

Two human studies looked at pregnancy outcomes following the repeated spraying of malathion, and another study looked at several different pesticides. These studies did not find a consistent increase in birth defects above the background risk. A study of 113 women who used a pyrethroid cream to treat head lice during pregnancy did not show an increased chance for birth defects or pregnancy complications. Some studies have suggested that pesticides might increase the chance of neural tube (spinal cord), heart, and hypospadias (opening of the urethra under the penis instead of at the tip) defects while other studies have not. One study suggested that atrazine, an herbicide, might increase the chance of gastroschisis (an opening in the baby’s abdominal wall). Contact a MotherToBaby specialist to see if there is more information on the specific product that you have questions about. 

Will exposure to pesticides increase the chance of other pregnancy-related problems?  

In animal studies, low birth weight and higher rates of fetal loss were seen at doses that were poisonous to the pregnant animal. In human studies, there were mixed reports on the effects on birth weight and the rates of gestational diabetes. One study found a higher chance for preterm delivery (birth before week 37) in counties of California that used higher levels of pesticides when compared to counties with lower pesticide use. Some studies have suggested that pesticides may increase the chances of asthma and cancers later in life. These studies are limited because although pesticides were used in the community, it does not mean the women in the study were actually exposed. Contact a MotherToBaby specialist to see if there is more information on the specific product that you have questions about. 

Does exposure to pesticides affect future behavior or learning for the child?  

Some studies have suggested that some pesticides might increase the chance for learning and behavior problems, including executive functioning, language, motor skills, attention deficit hyperactivity disorder (ADHD), and autism while other studies found no differences. Contact a MotherToBaby specialist to see if there is more information on the specific product that you have questions about. 

How can I minimize my exposure to pesticides?  

For all pesticides, it is important to carefully follow the recommendations on the label and safety data sheet. The labels should cover how to handle, store, and clean up spills. It should also outline if protective gear, such as gloves, is recommended. If possible, avoid mixing and applying pesticides yourself if you are pregnant. If that is not possible, exposure can be minimized by working in a well-ventilated area and using protective equipment such as a respirator, long sleeves, long pants, and gloves. It is unlikely that having your home or workplace treated by a professional exterminator will result in a high enough exposure to increase risks to a pregnancy. To reduce exposure to pesticides found on food, wash produce and your hands well before eating. 

Breastfeeding:  

Studies have not been done to look at the effects of pesticides while breastfeeding. The benefits of breastfeeding may outweigh the risk of exposure from pesticides sprayed in your home, workplace, or community. Be sure to talk to your healthcare provider about all your breastfeeding questions. 

If a man is exposed to pesticides at home or at work, can it affect fertility or increase the chance of birth defects? 

There are adult safety levels for pesticide exposure that should be followed in the workplace. In animal studies, high doses of malathion affected male fertility (ability to get a woman pregnant). A study of 152 farmers found that 62 males who had been exposed to either paraquat or malathion or both in various amounts had lower sperm count and motility than those not exposed. However, another human study compared men with high and low sperm counts and did not find a difference in the amounts of a malathion breakdown product in their bodies. In studies of other pesticides and herbicides, some studies suggested male fertility problems from exposure to pesticides and herbicides but other studies did not. Contact a MotherToBaby specialist to see if there is more information on the specific product that you have questions about. 

In general, exposures that males have are unlikely to increase the risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/. 

Please click here for references.